Classroom Lectures - The lectures include anatomy and physiology of the cardiovascular system, ECG rhythm interpretation, cardiac device technology and technical applications of cardiac pacing therapy.


1. 12-Lead Electrocardiography - This course is an extension of the Electrocardiography course and is designed to introduce the student to the theory and interpretation of 12-lead ECGs. The students will be expected to be able to interpret and diagnose ECGs of patient case studies and apply this knowledge clinically.


2. Advanced paced rhythms - ECG rhythms resulting from advanced pacemaker modes such as DDIR, DDDR, DVIR, VVIR, AAIR and others are presented and practiced. Much of this course is the interpretation of paced ECG's.


3. Antitachycardia Pacing Therapy (ATP) - The theory and principles of antitachycardia pacing are examined and discussed. This includes the mechanisms of tachycardias, ATP therapy, patient management and the operation of available antitachycardia devices.


4. Arrhythmic devices patient education - This class will present the principles of learning and learning concepts, patient assessment, psychosocial considerations, teaching plans and educational materials so that students may better educate and interact with individuals that are receiving a cardiac device or already have one implanted.


5. Patient Assessment - This course is designed to help students make a proper assessment of patients with cardiac devices. The material will include taking a patient history, performing a cardiac physical exam and diagnostic evaluation of the findings.


6. Atrial Fibrillation - This course discussed the types of atrial fibrillation, its mortality, and morbidity, as well as accepted and experimental treatments.


7. Basic electrophysiology (EP) - An introduction to electrophysiology is presented. Terminology, EP testing procedures, and the concepts of brady- and tachyarrhythmias are discussed. The specifics of electrophysiology testing in relation to bradycardias and tachycardias are examined and discussed. Particular attention is paid to tachycardia diagnosis and treatment as it relates to pacemakers, antitachycardia devices and implantable defibrillators.


8. Basic paced rhythms - ECG rhythms resulting from simple and basic pacing modes such as AAI, VVI, AOO, VOO, AAT, VVT are presented and practiced. Much of this course is the interpretation of paced ECG's.


9. Basic pharmacology - The important types of cardiac medications are discussed particularly in relation to cardiac pacing, implantable defibrillators, and major cardiovascular effects on patients.


10. Business and marketing of cardiac device technology - The business aspects of cardiac device technology will be introduced and taught. Particularly, business ethics, marketing oneself to an employer, business practices related to this field, how to conduct oneself in relation to healthcare providers, and other pertinent topics will be examined and discussed.


11. Business aspects of cardiac device technology - Industry personnel will visit and discuss their company specifically and the industry in general. They will be relating opportunities in the industry and how their company is involved in the cardiac device business. Former students will discuss "life in the real world" working with industry.


12. Cardiac anatomy & physiology - The anatomy of the heart and pertinent surrounding structures are taught. The physiology of the cardiac system is discussed as it relates to the pacing system and includes the myocardial cell, action potential and biochemistry of cell depolarization among others. The normal hemodynamics of the cardiovascular system are examined and discussed including cardiac output and the many factors affecting it. An introduction to cardiac pathology includes many disease processes of the cardiovascular system with the relationship to cardiac pacing.


13. Cardiac life support - Concepts related to BLS, ACLS, advanced defibrillation & cardioversion, and rescue pacing are presented and discussed. This class is taken in conjunction with CPR class.


14. Cardiac pathology - This course examines disease processes which affect the cardiovascular systems and includes lectures and discussions concerning atherosclerosis, ischemic heart disease, myocardial infarctions, valvular heart disease, heart failure, cardiac arrhythmias, hypertension and others.


15. Clinical electrophysiology - A more advanced treatment of the topic of electrophysiology is presented. Actual patient case studies will be discussed in detail related to initial patient assessment, clinical evaluation, and indications & contraindications for EP studies. Practical application of material taught in Basic EP will be applied here.


16. Computer applications in pacing & defibrillation - The importance of computer technology is presented and some basic  computer  skills are taught. Database management of follow-up information is discussed and demonstrated through the use of a customized patient follow-up database program.


17. Congestive Heart Failure - This course includes heart failure terminology, pathophysiology, mechanisms of cardiac resynchronization, implant procedures and device follow-up in the CHF Patient.


18. CPR - This course is offered to train students in cardiopulmonary resuscitation and includes CPR simulated training with infant, child and adult mannequins. The new automatic external defibrillators (AEDs) are discussed.


19. CRM Device Diagnostics - Examples of telemetered device diagnostics are given in a case study format for interpretation and discussion.


20. Diagnostic Tests - This course overviews ancillary cardiac testing such as Tissue Velocity Imaging, Micro-Volt T-Wave Alternans testing and Heart Rate Turbulence and their bearing on cardiac devices and arrhythmias.


21. Dual chamber rhythms - ECG rhythms resulting from dual chamber pacing modes such as DDD, VDD, DVI, DDI and DOO are presented and practiced. Much of this course is dedicated to interpretation of paced ECG's.


22. Electrocardiography - The course of electrocardiography will include normal ECGs as well as the recognition and diagnosis of brady and tachyarrhythmias. ECGs to include sinus, atrial, junctional and ventricular rhythms are presented and practiced. Much of this course is dedicated to the interpretation of non-paced ECGs.


23. Emergency and temporary pacing Various methods used in temporary pacing are presented. The types of available temporary pacemakers, associated hardware and circumstances for utilization is discussed. Unusual emergency pacing systems are presented and discussed including transesophageal pacing and transthoracic pacing.


24. Fundamentals of Electronics - Electrical concepts are presented including: Ohm's Law, field strength, stimulation thresholds, basic and derived quantities, units of measure, relationships, circuit and signal components, electronic subsystems, voltage, current and resistance, energy and power, and circuits.


25. Hardware and cardiac device/medical terminology - Students will gain a working knowledge of the terminology unique to the medical profession and specifically to cardiac devices. The accompanying hardware including pulse generators, leads, programmers, and accessories will be demonstrated, discussed and explained.


26. Hemodynamics of pacing - The use of specific pacemaker modes is reviewed as it relates to optimal cardiac hemodynamics.


27. History of cardiac stimulation - The history of cardiac stimulation is reviewed and then focused on relevant historical events concerning cardiac device systems.


28. ICHD code - The Intersociety Commission for Heart Disease Resources codes for the various designations of pacemakers and defibrillators are reviewed and discussed.


29. Implantable Cardioverter Defibrillators (ICDs) - The theory, indications, considerations, complications, troubleshooting, device interactions, and operations of various implantable cardioverter defibrillators (ICDs) are introduced. The newest "tiered therapy" devices and ICD technology are discussed. Included in this class is a historical review of the history of the ICD implant methods to include thoracotomy, abdominal approaches and use of patch electrodes.


30. Indications - The standard accepted indications for pacemaker and ICD implantation are presented and discussed. Also introduced are the more controversial and newer indications for devices.


31. Interviewing and Business Skills - This course will combine both lecture and mock interviews and business sessions to improve student skills in these areas. Video taping of mock interviews may be utilized.


32. Invasive EP Testing - Baseline assumptions & assessments for EP testing are presented and the evaluation of tachycardias is discussed. An overview of the EP lab, equipment and procedures will be discussed.


33. Medical Abbreviations - a discussion and demonstration of the types of medical abbreviations that the pacing professional will encounter in the clinical environment.


34. Medical jurisprudence - Liability, patient rights, legal risks, and the Safe Medical Devices Act of 1990 are presented and discussed in regards to cardiac device technology.


35. Pacemaker follow-up - Topics such as DRGs and pacing, EMI and magnet use, EOS indicators, complications, and myostimulation and myosensing are introduced and discussed. Clinical application of learned principles is expected. Topics relevant to cardiac device follow-up such as recalls & advisories, management of malfunctions, clinical investigations, exercise with pacing and setting up a follow-up lab are introduced and discussed. The choices between single and dual chamber pacemakers are examined. Why do patients receive a particular device? Why would some devices be inappropriate? What device may be more appropriate? Why a certain defibrillator? These questions and more are discussed to better understand the choices of cardiac devices available to patients and physicians.


36. Pacemaker implantation - All aspects of cardiac pacemaker implantation procedures are presented. This includes pre-implant considerations, operating room and catheterization laboratory procedures, sterile environments, testing of lead position, pacing systems analyzer testing procedures, ECG monitoring, adaptors and connectors, education of patients and troubleshooting for complications. Clinical application of learned principles is expected.


37. Pacemaker radiology - The basics of radiographic identification for the cardiac anatomy are presented. This knowledge is utilized to identify specific pacing devices, lead placement, polarity, integrity of the device system and potential complications such as lead dislodgment, lead fractures, connector pin problems, and others.



38. Pacemaker timing cycles - The timing cycles for the most common modes of pacing including VVI, DDD, and DDDR are introduced, discussed and practiced. Clinical application of learned principles is expected.


39. Pacing systems analyzer concepts - The concepts for the utilization of a pacing systems analyzer are introduced and discussed. Various features of a typical PSA are examined. Measurements and testing procedures utilized in a pacemaker implant with a PSA are discussed. Clinical application of learned principles is expected.


40. Patient Assessment - This course is designed to help students make a proper assessment of patients with cardiac devices. The material will include taking a patient history, performing a cardiac physical exam and diagnostic evaluation of the findings.


41. Pediatric Electrophysiology and Considerations - The concepts related to the subspecialty of pediatrics and cardiac device technology will be examined. Congenital anomalies that may result in an indication for a pacemaker or ICD implant as well as the management of devices in the pediatric patient will be discussed.


42. Programming concepts - Students are introduced to the concepts of programming single and dual chamber pacemakers and ICDs. The basic principles of programmers are introduced and individual programmers from various manufacturers are examined and discussed. This course is presented in conjunction with a laboratory.


43. Pulse generator specifications - Specific single and dual chamber pacemakers as well as ICDs are introduced. Specifications such as rate, mode, output and sensitivity settings are discussed along with any unique functions and features for that pacemaker. Pacing products from the various manufacturers are presented and compared. Specific features such as measured telemetry, diagnostics, programmability, sensor technology, connector compatibility, size and many others are examined. Much of this class will be presented by the cardiac device industry representatives.


44. Rate modulated pacing - The concepts of rate modulated pacing are introduced. All of the sensor technology is presented and examined in detail. The advantages and disadvantages of each sensor used in rate modulated pacing are discussed.


45. Recalls, regulatory terminology, and product performance - Recall and regulatory terminology is discussed, as well as how to handle a recall or advisory in the clinical arena.


46. Regulatory & cost issues - DRGs, registry, EP, ICDs, USA health care systems, Canadian healthcare, discharge planning, updated regulations, and managed care are topics to be presented and discussed in this course.


47. Research requirements with implanted devices - Reporting mechanisms, adverse secondary effects, clinical phases, MDS Act of 1990, IDE, components of IDE, reporting responsibilities, pre-market notification & application, and post-market surveillance are all topics to be presented and discussed in this course.


48. Safety - Infection control, radiation safety, electrical safety, drug interactions, device interactions, and EMI are presented and discussed in relation to the hospital and clinical environment. These lectures will typically be conducted on-site at our affiliate hospitals.


49. Selective Site Pacing - This course evaluates the impact of RV apical pacing and investigates alternative pacing sites in both the atria and the ventricles.


50. Technical aspects of cardiac device technology - The various design components of pacing leads, pacemakers, and ICDs are presented by industry personnel such as field engineers and technical specialists. New technology is discussed, particularly, as it relates to new products.


51. Tilt table testing (EP) - This course will introduce the topic and rationale of tilt table testing in the EP laboratory. The indications & contraindications, pathophysiology of neurally mediated syncope, tilt table procedures, treatment plan & evaluation as well as patient education will be presented and discussed.


52. Troubleshooting paced rhythms - Specific paced ECG's are examined and discussed pertaining to pacer and lead malfunctions, sensing and capture problems, pseudomalfunctions, ECG misinterpretation and others. Troubleshooting procedures and options are discussed. Practical examples from the clinical setting are utilized.


53. Upper rate response - All aspects related to upper rate behavior of pacemakers are presented and examined in detail. This includes multi-block, Wenckebach, fallback, rate smoothing, and mode switching features. Advantages and disadvantages will be discussed. Clinical application of learned principles is expected.


54. Remote Follow Up - Students will learn how the various manufacturer's offer the capabilities for implanted devices to be followed remotely from offsite locations, including patient homes. These capabilities will be compared and a full understanding of this new and exciting technology will be expected.


II. Skills Laboratories and Clinical Experience - These two learning approaches coincide with specific classes to provide an opportunity for hands-on experience in a simulated or closely supervised environment.


1. Electrophysiology laboratory - Students observe and participate in the EP lab. The clinical experience will include cardiac device implants, catheter ablations, and EP studies.


2. Follow-up laboratory - Students are exposed to the follow-up of patients with implanted single and dual chamber pacemakers including rate modulation devices. Clinical experience involves observation and, later, participation. This course is the practical application of "Follow-up concepts."


3. Journal Club and clinical case studies Students read, interpret and present reports from current medical literature. Later, as they become more involved in actual clinical scenarios, they present pertinent patient case studies for discussion with the class.


4. Pacing systems analyzer laboratory - Students are exposed to the pacing systems analyzer and its functions. Many hours are designated on different manufacturer's PSAs in conjunction with a heart simulator. Eventually, the student participates in the implantation surgeries and utilizes the skills learned for the PSA. Much of this class will be dedicated to student practice to attain necessary skills.


5. Programming concepts laboratory - Students are provided the opportunity to learn and practice with a variety of device programmers for the various single and dual chamber pacemakers as well as the ICDs. Many demonstration cardiac devices including the rate modulated pacemakers are utilized to provide a wide range of devices with each programmer. Much of this class will be dedicated to student practice to attain adequate skills.


6. Pulse generator specifications lab Students examine the specifications of various single and dual chamber pacemakers and implantable defibrillators by studying the various manufacturers' manuals. Students will provide oral reports on their studies.


III. Clinical Practicum - The student experiences on-the-job training in the hospital and clinical setting including cardiac device implant surgeries, cardiac device follow-up and the electrophysiology lab.


TOTAL: 1,080 clock hours